Fundamentals of Geriatric Pharmacotherapy: An Evidence-Based Approach 2e

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In January 2010, a social demographic change began in the United States as the Baby Boomer generation began to turn 65 years of age. Persons near or across this threshold are likely to claim that chronological age is not reflective of their true age and vitality. If being 50 is the new 35, what does that make 75? Aging or being “old” is not a well accepted or welcomed stage of life in our culture. Anti-aging therapies, ranging from skin creams that affect cosmetic appearance to individualized hormone regimens that increase or maintain muscle mass and vitality and diminish the appearance of age, dominate the market and media spotlight while shaping the national conscience of how we think about aging. It is unfortunate and damaging that such an industry can delude the public and tarnish the real champions—older adults. Pharmacists have a role in setting this record straight. The golden age of geriatric clinical pharmacology was the 1970s and 1980s, when basic age-associated pharmacokinetic and pharmacodynamics changes were identified. Since then, information on the efficacy and safety of new drugs, and how to dose and monitor them, has been generated by pharmacoepidemiologic studies, pooled, and secondary analyses of trials of persons above a certain age included in the trials. The pearls of geriatric pharmacotherapy are not generated from such trials and findings, but by experienced and intellectually curious clinicians and scientists such as those chosen to contribute to this text. To my knowledge, the first recognized pharmacist-leaders in geriatrics were Ron Stewart and the late Peter Lamy. Their contributed works and mentorship directly affected many of the authors of this textbook. That the field of geriatrics has been atrophying is well documented: training programs continue to decline in number, geriatrics continues to be underemphasized in curriculums, and practices cannot survive on Medicare alone. All workforce predictions conclude that the U.S. healthcare education system cannot train enough pharmacists, physicians’ nurses, and other professionals to meet the demand. Thus, all healthcare providers, including pharmacists, must have working competencies in geriatrics to care for the nation’s aging population. That is where this text can be of great value and contribution. Once again divided into two sections, General Social, Ethical, Economic, and Biomedical Issues of Aging, and Pharmacotherapy Issues of Aging, the second edition of Fundamentals of Geriatric Pharmacotherapy provides a comprehensive knowledge and reference for both novices and experienced clinicians. For the second edition, each chapter has been updated and several expanded, notably Palliative and Hospice Care. Each chapter includes learning objectives that will be useful for educators and self-learners. Geriatrics, like all specialties, has its own language, and the key terms defined in each chapter compose a helpful glossary for understanding this language. Rather than a stand-alone chapter on demographics, the chapter Challenges in Geriatric Care nicely integrates terminology with demographic changes and puts chronological age into context with other variables that must be considered when providing care for the older patient. The clinical pearls, key points, cases, and questions in each chapter provide the reader with clinical insight not found in clinical trials, meta-analyses, or systematic reviews. The case histories accurately represent the complexity and decision-making encountered when caring for geriatric patients in a variety of clinical settings, providing especially good exposure for the student reader. How to interpret and critique clinical trials for their geriatric content and implications for care are discussed in detail, with examples in several chapters.

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